Class Challenges Medical Billing Practice

ST. LOUIS (CN) – A class action claims Washington University’s “balanced billing” for medical services violates Missouri’s Merchandising Practices Act. In balanced billing, a common practice among health-care providers, patients are billed for the difference between what the insurer paid and what the provider charged for the medical services.




     Named plaintiff Steven Powell uses a chain of reasoning to claim that balanced billing violates state law.
     He claims that health-care providers set the prices for medical goods and services arbitrarily; that the amount that insurers pay for the services is of reasonable value; that after accepting a payment of reasonable value from the insurer, the health-care provider bills the patient an additional amount, in excess of the reasonable value; that if the amount the insurer agreed to pay and the charge established by the health-care provider were fair and reasonable, then both amounts would be the same and therefore no balance would be left over; and that health care providers bill Medicare one amount, insurers a different amount, and uninsured and underinsured patients an even greater amount for the same services.
     Powell says that Washington University practiced balanced billing on him. After he refused to pay, the university sued and obtained a consent judgment against him for an amount “over and above the fair” amount Washington University had agreed to accept.
     “The Missouri Merchandising Practices Act was enacted by the Missouri Legislature to protect the citizens of Missouri from deceptive, unfair, arbitrary, capricious and discriminatory billing practices.
     “The conduct of defendant The Washington University as described above, was and is intentional and constitutes a clear violation of the Missouri Merchandising Practices Act,” the complaint states.
     The class consists of all uninsured or underinsured Missourians who have been subject to balanced billing since 2000. It seeks actual and punitive damages. It is represented in City Court by Paul Passanante with Passanante & Associates.

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